40 - Upper Hemisphere Oncoplastic Surgery

Abstract

The application of oncoplastic breast surgery techniques in upper hemisphere breast conservation surgery (BCS) affords optimal oncologic and aesthetic outcomes via case-by-case tailored procedures. The goal of this chapter is to provide breast surgeons with multiple reproducible techniques for performing oncoplastic surgery (OPS) in the upper hemisphere. Although the upper hemisphere is often thought of as a “less than ideal” or “less forgiving” location for surgery, multiple OPS techniques are available. The inherent necessity of a breast surgeon to have an armamentarium of OPS techniques is not only a reflection of the variety of breast shapes and sizes, tumor sizes, and tumor locations, but also the increased eligibility of patients for BCS and the demonstrated benefit of OPS. A variety of reproducible OPS techniques, including full-thickness resection and anatomically ideal incision placement, are accessible to the breast surgeon. Multiple techniques to address large-volume OPS resection in any location within the upper hemisphere include modified Benelli (also known as modified round block mastopexy), racquet mastopexy, skin-sparing mastopexy, and modification of the Wise pattern for upper outer and upper inner breast tumors. Several OPS classification systems have been proposed, including bilevel classification, four main categories classification, lower level, upper level, and highest level classification, and a system based on difficulty of the tissue/skin rearrangement and volume of resection level 1 through 4. To further demonstrate the feasibility of performing OPS as a breast or general surgeon, a recent study found no statistical difference in the risk of postoperative complications when surgery was performed by either of the two specialty services (plastics or breast surgeon).